硬膜外不同浓度甲磺酸罗哌卡因复合七氟醚全麻用于老年食管癌手术的研究

Study of elderly patients undergoing esophageal carcinoma surgery under combined different concentration ropivacaine and sevoflurane general anesthesia

目的比较硬膜外不同浓度的甲磺酸罗哌卡因复合七氟醚吸入全麻用于老年患者食管癌手术时生命体征的变化。方法 60例择期开胸食管癌手术老年病人随机分为2组,组1、组2术中硬膜外分别给予0.447%甲磺酸罗哌卡因与0.298%甲磺酸罗哌卡因。硬膜外成功后行全麻诱导插管,调节吸入七氟醚的浓度维持BIS值在50～55之间,记录术中各时刻MAP、HR、BIS、七氟醚的呼气末浓度(FESEV)。结果手术开始后90 min内组1 MAP、HR与基础值比较下降(P<0.05),组2 MAP、HR与基础值比较无显著差异(P>0.05),组1与组2比下降(P<0.05)。90 min后组1与组2 MAP、HR与T0比较无显著差异(P>0.05),两组间比较亦无显著差异(P>0.05)。组1与组2比较发生低血压与心动过缓的次数增加(P<0.05)。结论与0.447%甲磺酸罗哌卡因相比,硬膜外0.298%甲磺酸罗哌卡因复合七氟醚全麻用于老年患者食管癌手术,能够提供充分的镇痛,术中生命体征也更加平稳。

Objective： To compare the changes of vital signs among elderly patients undergoing esophageal carcinoma surgery under combined different concentration ropivacaine and sevoflurane general anesthesia.Methods： Sixty elderly patients scheduled for esophageal carcinoma surgery were randomly assigned to two groups receiving 0.447% ropivacaine（Group 1） or 0.298% ropivacaine（Group 2）.Anesthesia was induced and trachea was intubated when epidural block was successfully performed.Sevoflurane administration was then titrated to maintain BIS between 50 and 55.The MAP,HR,BIS,FESEV（End-tidal sevoflurane concentration） were recorded during the surgical procedure.Results： MAP and HR were significantly reduced in Group 1,but not in Group 2 within 90 minutes.No significant differences were observed between Group 1 and 2 after 90 minutes.Significant hypotension and bradycardia occurred in Group 1,but not in Group 2.Conclusion： Epidural administration of 0.298% ropivacaine combined with sevoflurane general anesthesia leads to an adequate anesthetic depth and less variable values of vital signs when compared with a 0.447% concentration of ropivacaine.